Module 04: Administration of Medication

Question 1

This is the administration of a drug into the dermal layer of the skin just beneath the epidermis.

Answer 1

Intradermal Injection

Question 2

The intradermal injection is frequently used for what?

Answer 2

For allergy testing and tuberculosis (TB) screening

Question 3

Which arm is usually used for intradermal injections?

Answer 3

The left arm is commonly used for TB screening and the right arm is used for all other tests.

Question 4

How is the intradermal injection characterized?

Answer 4

Administering ID injections is an invasive technique that involves the application of nursing knowledge, problem-solving and sterile technique.

Question 5

What should the nurse do in terms of administering intradermal injection?

Answer 5

The nurse should inform about symptoms of allergic reactions and the necessity of reporting those observations immediately to the nurse.

Question 6

What should the nurse do during the assessment process prior to administering intradermal injections?

Answer 6

Assess the following:
(1) Appearance of the injection site
(2) Specific drug action and expected response
(3) Client’s knowledge of drug action and response
(4) Check agency protocol about the sites to use for skin tests.

Question 7

What are the equipment used for administering medications?

Answer 7

(1) Prescribed medication
(2) Dry cotton balls
(3) Client’s medication record and chart
(4) Cotton balls with alcohol
(5) Tuberculin syringe with 26G to 27G or 1/2 to
(6) 3/8 needle (For intradermal)
(7) Medication Tray
(8) Clean Gloves
(9) 3 to 5 mL syringe (For intramuscular)
(10) 20G to 25G needle (For Intramuscular)
(11) Pen

Question 8

What should the nurse do during the preparation process prior to administering injections?

Answer 8

(1) Check medication order and client’s charts. Check medication label against prescription to ensure correct medication is being prepared.
(2) Prepare materials and equipment.
(3) Perform hand hygiene and observe appropriate infection control prevention procedures.
(4) Prepare the medication from vial or ampule.
(5) Introduce self and verify patient identity.
(6) Explain the procedure ensuring that the client understands that the medication will produce a blab or wheal which needs to be interpreted after a few hours. The reaction to the medication administration will gradually disappear after.
(7) Provide for privacy and comfort.

Question 9

What should the nurse do during the performance process prior to administering intradermal injections?

Answer 9

(1) Select the site (forearm)
(2) Site should not be tender, inflamed, swollen and with lesions

Question 10

How is the forearm characterized when applying intradermal injections?

Answer 10

Forearm: About a hand’s width above the wrist and 3 to 4 fingerbreadths below the antecubital space

Question 10

How should the nurse sanitize the injection site when administering the intradermal injection?

Answer 10

Apply gloves and disinfect the site using circular motion from the center outward. Allow the site to dry (airdry).

Question 11

How should the nurse prepare the syringe when administering the intradermal injection?

Answer 11

(1) Expel air bubbles
(2) Grab the syringe with dominant hand and hold between the thumb and the forefinger
(3) Hold the needle, bevel up almost parallel to the skin surface
(4) With the nondominant hand, pull the skin until taut.
(5) Insert the tip of the needle far enough to place the bevel through the epidermis with the outline of the bevel visible under the skin surface,
(6) Stabilize the syringe and needle and inject the medication slowly to produce a wheel.
(7) Withdraw the needle quickly at the angle of insertion
(8) Do not massage the area
(9) Discard syringe and needle together in a sharps container
(10) Discard gloves and perform hand hygiene

Question 11

What should be the angle when administering the intradermal injection?

Answer 11

10 to 15 degrees only

Question 12

What are the three (3) layers of the skin?

Answer 12

(1) Epidermis
(2) Dermis
(3) Subcutaneous Tissue

Question 13

What should the nurse do after administering the intradermal injection?

Answer 13

Using a blank ink, circle the injection site to observe for redness or induration.

Question 14

What should the nurse include when labeling the site of injection after administering intradermal?

Answer 14

(1) Time of injection
(2) Signature or initials

Question 15

What should the nurse do after administering the intradermal injection?

Answer 15

(1) Assess the client’s response to the procedure. Provide reassurance.
(2) Document the medication tested, the time and dosage administered, route and site.

Question 16

What should the nurse evaluate after administering the intradermal injection?

Answer 16

(1) Evaluate the client’s response to the testing substance.
(2) Evaluate the condition of the site in 24 or 48 hours, depending on the test. Measure the area of redness and induration in millimeters at the largest diameter and document findings.

Question 17

Why should the nurse evaluate the client’s response to the testing substance?

Answer 17

Some medications used in testing may cause allergic reactions. Epinephrine may need to be used.

Question 17

These are absorbed more quickly than subcutaneous injections because of the greater blood supply to the body muscles.

Answer 17

Injection to the muscle tissue or intramuscular injection (IM)

Question 18

How can a patient be suitable for an intramuscular injection?

Answer 18

An adult with a well-developed muscles can usually safely tolerate up to 3mL of medication in the gluteus medius and gluteus maximus muscles.

Question 19

How much volume is usually recommended for adults with less developed muscles?

Answer 19

1 to 2 mL

Question 19

How much volume is recommended when administering in the deltoid muscle?

Answer 19

Volumes of 0.5 mL to 1mL are recommended

Question 20

What kind of syringe is needed for intramuscular injection?

Answer 20

Usually a 3 to 5 mL syringe is needed. The size of the syringe used depends on the amount of medication being administered.

Question 21

This is the site preferred when administering intramuscular injections.

Answer 21

The ventrogluteal site

Question 22

Why is the ventrogluteal site preferred for intramuscular injections?

Answer 22

(1) Contains no large nerves or blood vessels
(2) Provides the greatest thickness of gluteal muscle consisting of both the gluteus medius and gluteus minimus
(3) Is sealed off by bone
(4) Contains consistently less fat than the buttock area, thus eliminating the need to determine the depth of the subcutaneous fat.

Question 23

This is usually the thick and well developed muscle in both adults and children.

Answer 23

Vastus Lateralis

Question 24

Vastus lateralis site is recommended to whom when administering intramuscular injections?

Answer 24

It is the recommended choice of site for IM injection for infants and young children because it has the largest muscle mass.

Question 25

Which portion of the vastus lateralis is recommended to whom when administering intramuscular injections?

Answer 25

The middle third of the muscle is suggested as the site.

Question 26

in adults how is the vastus lateralis established when administering intramuscular injections?

Answer 26

By dividing the area between the greater trochanter of the femur and the lateral femoral condyle into thirds and selecting the middle third.

Question 27

This belongs to the quadriceps muscle group and is used only occasionally for IM injections.

Answer 27

Rectus Femoris Site

Question 28

What is the chief advantage of the rectus femoris site?

Answer 28

Clients who administer their own injections reach this site easily

Question 28

Where is the Rectus Femoris Site found?

Answer 28

It is situated in the anterior aspect of the thigh.

Question 29

What is the chief disadvantage of the rectus femoris site?

Answer 29

An injection here can cause considerable discomfort.

Question 30

This is found in the uppermost part of the upper arm and is a relatively a small muscle.

Answer 30

Deltoid Site

Question 31

How much solution should be administered in the deltoid site when administering intramuscular injections?

Answer 31

No more than 1mL of solution can be administered

Question 32

Why is the deltoid site recommended when administering intramuscular injections?

Answer 32

It is recommended for the administration of immunizations and vaccines in adults because these medications are usually small in volume.

Question 33

How should the nurse locate the deltoid site when administering intramuscular injections?

Answer 33

The nurse locates the upper landmark for the deltoid site by placing four fingers across the muscle with the first finger being on the acromion process.

Question 34

Where is the deltoid site?

Answer 34

The top of the axilla is the line that marks the lower border landmark. A triangle within these boundaries indicates the deltoid muscle above 5cm (2in) below the acromion process.

Question 35

How should the nurse assess when administering intramuscular injections?

Answer 35

Assess the following:
(1) Client allergies to medications
(2) Specific drug action, side effects and adverse reaction s
(3) Client’s knowledge of and learning needs about the medications
(4) Tissue integrity of the selected site
(5) Client’s age and weight to determine the site and needle size.
(6) Client’s ability or willingness to participate.

Question 36

How should the nurse perform the administration of intramuscular injections?

Answer 36

(1) Check the physician’s order in the chart and ensure correct medication has been prepared
(2) If feasible, change the needle used to withdraw the medication to a new one.
(3) Provide privacy and position the client.
(4) Explain the purpose of the medication and other important information.
(5) Select the site free of lesion, tenderness, swelling, hardness and localized inflammation
(6) Wear clean gloves
(7) Clean the site with wet cotton balls or antiseptic swab using circular motion from the center moving outward (2in around the site). Allow skin to dry.
(8) Administer the Z-track technique (90 Degrees)